Will California remember the lessons of the COVID health emergency?

In secret warehouses strategically placed across the state, California is keeping a vast stockpile of essential medical supplies, including masks, gloves and life-saving medications, in hopes of being better equipped than during the COVID crisis.

Four years after the coronavirus turned our lives upside down and a new viral threat emerged, public health experts are asking: What else have we learned from the pandemic?

Although California is much better prepared, health experts say further assessment suggests more testing, more sustained funding and stronger national leadership are needed if they hope to implement their well-crafted plans.

“We have learned a lot. We are better positioned to meet the next threat,” said Dr. Sarah Rudman, deputy health officer for Santa Clara County, which recorded the nation’s first COVID-19 death.

But potential new threats are emerging – even as provinces face budget cuts that could sacrifice their future preparedness. As a public health emergency fades, so does the focus, Rudman said.

So far, the public health risk from bird flu, or H5N1, is low. Of the four people who contracted H5N1, three were exposed to dairy cows and one to infected poultry. All cases in the US were mild, and none occurred in California.

But the virus is spreading to multiple mammal species.

“It’s a red flag,” said Dr. John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley. “It’s a very small risk, but there is potential – and I don’t think we’re responding as strongly as we should be.”

The concern, says Dr. George W. Rutherford of UC Berkeley’s School of Public Health, is that the virus will accumulate genetic mutations that allow it to jump from animals to humans — and then spread.

Health experts see successes and failures

California’s “SMARTER” plan, announced in 2021, is a seven-part strategy that increases preparedness. The “S” in the acronym stands for access to recordings; M, for masks; A, for consciousness; R, for readiness; T for testing; E for education and R for Rx, or medical treatment.

In the early days of the pandemic, Bay Area hospitals and county health clinics were so desperately short of medical supplies that they appealed to the public for donations of N95 masks, gowns and gloves. Under former Governor Arnold Schwarzenegger, the state had spent hundreds of millions of dollars buying and stockpiling supplies. But when the 2008 recession devastated the state budget, they were given away to save on storage costs.

Now, hospitals, skilled nursing facilities, dialysis clinics and medical practices that are part of a larger health care system are required to stock up on a 45-day supply of personal protective equipment such as masks and gloves.

And the state has several “strategically placed” warehouses, in partnership with the Strategic National Stockpile, that hold a stockpile of protective equipment, emergency medicines and other supplies. According to the California Department of Public Health, inventory is rotated and updated to avoid expiration.

“It’s a very good, solid plan,” Swartzberg said. “The people who put this together thought about the big things.”

“But there is one big caveat: We are not an island,” he said. “If we are really well prepared – but the US in general is not well prepared – then it will be difficult for us to implement this plan.”

That’s because California must follow guidelines from the U.S. Centers for Disease Control, he said. And California doesn’t have the manufacturing capacity to produce everything it needs.

According to digital medical news site STAT, the federal government has been working with flu vaccine manufacturers to develop and test batches of H5N1 vaccines that target different versions of the virus. About 10 million doses are being stockpiled in bulk, according to David Boucher, director of infectious disease preparedness and response for the federal government’s Administration for Strategic Preparedness and Response.

But two doses per person wouldn’t go far. Manufacturing an avian flu vaccine, which uses eggs, takes longer than the mRNA system developed for COVID. It could disrupt production of the seasonal flu vaccine.

And experts like Rutherford worry about fighting bird flu with an egg-based vaccine because chickens can be lost.

And while the federal government has made efforts to increase the supply of supplies, “there hasn’t been a lot of transparency. It is difficult to assess whether this is sufficient,” said Jennifer B. Nuzzo, director of the Pandemic Center at Brown University School of Public Health.

California businesses need more help navigating the recommendations or mandates of public health experts, Swartzberg said. At the height of the pandemic, large companies could afford private consultants, but smaller companies could not.

Companies specifically lack expertise in optimizing air exchange, managing exposure, conducting quarantines and isolation, and communicating the importance of vaccination. They also need testing protocols for testing employees.

To speed economic recovery, businesses need easier access to capital or grants beyond federal disaster loans, as well as mentoring to create new sales channels, according to a report from the Regional Small Business Development Center Networks of California.

Better surveillance and testing would alert us to the arrival of a deadly virus.

The CDC tracks overall levels of influenza A in sewage, but does not test for specific subtypes, such as H5N1. Testing of wastewater specifically for the bird flu virus will be scaled up nationally this summer. WastewaterSCAN, a sewage surveillance network for infectious disease tracking led by Stanford University and Emory University in partnership with Verily Life Sciences, will monitor samples from 190 locations at treatment plants in 36 states.

Many California counties, including Santa Clara, Alameda and San Francisco, also monitor influenza A levels in wastewater and then test for H5N1 if they experience an atypical spike in influenza A activity.

While samples of pasteurized milk are tested at retail, testing of animals for H5N1 is voluntary except when cows are moved across state lines.

And few people are being tested, in part because people who work on farms are reluctant to volunteer.

Cuts could undermine the state’s preparedness. Facing a $44.9 billion budget deficit, Governor Gavin Newsom has proposed $300 million in cuts to public health funding.

This would not only downsize the California Department of Health, but also local health care jurisdictions, putting more than 1,200 jobs at risk.

“There are a number of lessons learned from the COVID pandemic that have put us in a much better position to meet the next threat,” Rudman said. “But our ability to do so is at risk.”

“What’s tricky about pandemic preparedness is that we don’t know much about what will happen to us next,” she said. “Except it’ll be different from what happened to us the other day.”

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